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Glossary

Olecranon screw traction is a useful technique for fractures that are not amenable to closed reduction and K-wire fixation.

In emerging healthcare settings, this may be a useful technique for severely displaced 13-M/3.1 III, 13-M/3.1 IV, 13-M/3.2 III and 13-M/3.2 IV fractures.

Indications for this technique are rare in settings where operating facilities, image intensification and the requisite specialist skills are readily available.

Manipulation of a displaced fracture in a child is painful and is very difficult with awake-sedation techniques. General anesthesia is therefore required for insertion of the olecranon screw and arrangement of the traction system.

A stab incision is made directly over the subcutaneous proximal ulna directly opposite the tip of the coronoid process. Palpating the radial head may help to identify the level of the coronoid process.

Pearl: If the muscle is stuck despite traction, a milking maneuver can be attempted.

Starting proximally at the humeral head, the brachialis muscle is gently and repeatedly "milked" distally and anteriorly in order to liberate the soft tissues from around the protruding proximal fragment.